Diagnostic criteria for dysthymic disorder

The DSM-III (American Psychiatric Association 1980) criteria for dysthymic disorder selected a heterogeneous group of patients who overlapped with major depression and personality disorders in ways that were difficult to interpret. DSM-III-R (American Psychiatric Association 1987) revised the dysthymia criteria by (1) distinguishing early from late age of onset; (2) providing separate designations for primary and secondary states of dysthymia; (3) including a category of chronic major depression; and (4) revising the specific content of criteria. The performance characteristics of the new criteria set are yet to be tested--a necessary next step to inform the discussions that will culminate in DSM-IV. The remaining areas of greatest controversy are whether (1) early onset, primary dysthymic disorder should be redefined as depressive personality and placed on Axis II; (2) "double-depression" represents a real clinical phenomenon or a definitional artifact; and (3) the content of the diagnostic criteria can be made more specific for chronic depressions. The implications of possible changes and the workings of the DSM-IV Affective Disorders Work Group are discussed.